Research News

In the late 1960s and early 1970s, targeting of the “posterior subthalamic area (PSA)” was explored by different functional neurosurgical groups applying the radiofrequency (RF) technique to treat patients suffering from essential tremor (ET). Recent advances in magnetic resonance (MR)-guided focused ultrasound (MRgFUS) technology offer the possibility to perform thermocoagulation of the cerebellothalamic fiber tract in the PSA without brain penetration, allowing a strong reduction of the procedure-related risks and increased accuracy. This study describes the first results of the MRgFUS cerebellothalamic tractotomy (CTT) as an effective and safe approach for patients with therapy-refractory essential tremor, combining neurological function sparing with precise targeting and the possibility to treat patients bilaterally.

Lack of awareness of involuntary movements is a curious phenomenon in patients with certain movement disorders. An interesting anecdotal observation is that patients with essential tremor (ET) often seem unaware of their own head tremor. In this study, ET patients were asked whether they were aware of head tremor while it was occurring on examination, thereby allowing us to gauge real-time awareness of their involuntary movement.

Although syndromes that cause voice tremor have singular characteristics, the differential diagnosis of these diseases is a challenge because of the overlap of the existing signs and symptoms. This study aims to develop a task-specific protocol to assess voice tremor by means of nasofibrolaryngoscopy as a viable method to differentiate between essential and dystonic voice tremor syndromes.

I am delighted to inform the National Tremor Foundation that after considerable activity by my colleagues Professor Wladyslaw Gedroyc (consultant radiologist), Mr Dipankar Nandi (consultant neurosurgeon) and me, we have obtained £1,250,000 from the Imperial College Healthcare Charity trustees to purchase a MR-Guided Focussed Ultrasound (MRgFUS) machine for Imperial College Healthcare NHS Trust.

Essential tremor usually manifests as a postural and kinematic tremor of the arms, but may also involve the head, voice, lower limbs and trunk. An oscillatory network has been proposed as a neural correlate of ET, and is mainly composed of the olivocerebellar system, thalamus and motor cortex. Their non-invasiveness, along with their side effects profile, makes them an appealing treatment option. In addition, peripheral stimulation has been applied in the same perspective. The aim of this review is to shed light on the emergent use of noninvasive central and peripheral stimulation techniques in this interesting context.

The clinical benefits of targeting the ventral intermediate nucleus (VIM) for the treatment of tremors in essential tremor (ET) patients suggest that the VIM is a key hub in the network of tremor generation and propagation and that the VIM can be considered as a seed region to study the tremor network. Findings from this study provide the first evidence that the pathological tremors observed in ET patients might be based on a physiologically pre-existing VIM-motor cortex (MC)-cerebellum (CBLM) network and that disruption of functional connectivity in this physiological network is associated with ET.

Study to evaluate the safety and efficacy of unilateral Gamma Knife thalamotomy (GKT) for treatment of severe tremor with a prospective blinded assessment. This blinded prospective assessment demonstrates that unilateral GKT is a safe and efficient procedure for severe medically refractory tremor. Side effects were rare and transient in this study.

The International Essential Tremor Foundation (IETF) is pleased to announce proposals are now being accepted from researchers whose investigation addresses the nosology, etiology, pathogenesis, treatment or other topics relevant to essential tremor (ET). The submission deadline for proposals is February 28, 2016. The announcement of the award will take place on June 1, 2016 with the funding period to begin July 1, 2016.